To me, the amniotic membranes are an amazing and beautiful thing. They embody the concept of strength in flexibility. Being so incredibly thin and yet such a tough defender of the babe. Keeping the baby tucked inside; encompassing the salty, warm, nurturing environment of the womb. When I do vaginal exams (which is not that often) during labor, and I feel that filmy, slippery membrane I am constantly in awe of its power. The veil at the doorway that separates our two worlds. In our current birth culture being born en caul is rare, even more rare than perhaps it has been historically.
The laboring person was sitting on the birth stool with a bulging bag of waters crowning. Through the bag and the waters, I can see specks of vernix floating in the clear fluid. I can also see lovely dark hairs dancing and swirling, suspended in the waters, moving in tune with the woman and the birth rushes. For a moment, I am transfixed by the beauty. Then with a grand grunt, I am pulled back and place my hand on the babe’s head…expecting the bag to break and flood me with a wave, but it doesn’t budge. Instead, I apply some mild downward pressure and the babe is birthed, bag and all, into my hands. After working him out of his bag up to his parents he went.
Before I was a community based midwife, I worked for several years as a nurse in the hospital. I was constantly shocked at the often flippant way the membranes were regarded. So easily ruptured with little to no explanation to the mother as to why. Sometimes, even ‘just done’ and not even mentioned until after the break! Such a routine intervention, to the point of not really being considered an intervention. As a midwife, I have used AROM (artificial rupture of membranes), but very sparingly. To me, it is a serious intervention and one that significantly impacts the babe’s experience; a sudden, potentially jolting change. Don’t get me wrong, sometimes it is an appropriate and helpful intervention. I just don’t like the ‘routine-ness’ of it in certain settings. When I have done it, it has been after careful consideration and thoughtful discussion with my client and their partner. I have had several families, after this discussion decline the AROM. On the other hand, I have had some clients who, from previous experience have thought that the membranes had to be ruptured for the birth to happen, that they would hold things up and get in the way. A very popular question from family members when they feel things are ‘taking too long’ is “aren’t you gonna break the bag?” This has become part of our culture of birth and cultures are a hard thing to overcome. In my experience, the membranes most often release on their own, in their own time. Sometimes they don’t release and the babe is born with them intact. When a babe is born in their amniotic sac, it is called being “born en caul” and it has been ascribed many meanings by many different cultures. I have read several of these meanings and have found them all to be positive. The common associations are that this child will be a leader of their people, they will have the ‘sixth sight’, they will never perish by drowning, etc. (I would love to hear of any other known associations.) I believe that we see many more of these births at birth centers and at home because routine AROM is not widely practiced. Which then leads me to wonder; are we, by fostering gentle, honored birth, fostering a generation of visionary leaders? What do you think?
Image credit Aubre Tompkins, CNM